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目的在扩散加权成像(DWI)用于标准临床实践的反应监测之前,需要评估其数据的可重复性,即个体可检测到的正常变异范围之外的差异数据。本研究对结直肠癌肝转移瘤表观扩散系数(ADC)值的可重复性进行评估,为了提供其生物学基础,同时评估了ADC值与相应病理组织学之间的关系。方法对计划行结直肠癌肝转移瘤切除术的病人一周行2次DWI检查,然后评价ADC值与细胞凋亡标志物p53、抗凋亡蛋白BCL-2、增殖标志物Ki67、血管内皮生长因子(VEGF)浓度之间的关系。结果对21个结直肠癌肝转移瘤观察研究发现具有良好可重复性的平均ADC值(可重复系数为0.20×10-3mm2/s),该ADC值与转移瘤的增殖指数和BCL-2表达相关,另外,近期内进行过系统治疗的转移瘤具有明显更高的ADC值[(1.27×10-3)mm2/s∶(1.05×10-3)mm2/s,P=0.02]。结论良好的可重复性、与组织病理学良好相关性以及对系统性治疗诱导的抗肿瘤效应的显示的敏感性,均提示DWI可能成为监测转移性结直肠癌治疗反应的一种极好的检查手段。要点①ADC值正在成为肿瘤学新的生物学指标。②DWI为结直肠癌肝转移瘤提供了一个可重复的ADC值。③结直肠癌转移瘤平均ADC值的可重复系数为0.20×10-3mm2/s。④ADC值与转移瘤的增殖指数和BCL-2表达相关。
Purpose Before diffusion-weighted imaging (DWI) is used for response monitoring in standard clinical practice, it is necessary to assess the reproducibility of its data, ie, differences in data beyond the range of normal variation detectable by individuals. This study assessed the reproducibility of apparent diffusion coefficient (ADC) values for metastatic tumors of colorectal cancer. In order to provide their biological basis, the relationship between ADC values and the corresponding histopathology was also assessed. Methods DWI was performed twice a week in patients scheduled for resection of colorectal cancer with liver metastases. Then the ADC values were compared with those of apoptosis markers p53, anti-apoptotic protein BCL-2, proliferation marker Ki67, vascular endothelial growth factor (VEGF) the relationship between the concentration. Results The average ADC value (repeatability coefficient was 0.20 × 10-3mm2 / s) with good reproducibility was found in 21 colorectal cancer liver metastases. The ADC value was correlated with the proliferation index and the expression of BCL-2 In addition, recently treated systemic metastases have significantly higher ADC values [(1.27 × 10 -3) mm 2 / s: (1.05 × 10 -3) mm 2 / s, P = 0.02]. Conclusions Good reproducibility, good correlation with histopathology, and sensitivity to systemic therapy-induced antitumor effects suggest that DWI may be an excellent test for monitoring treatment response to metastatic colorectal cancer means. Points ① ADC value is becoming a new biological indicator of oncology. DWI provides a reproducible ADC for colorectal liver metastases. ③ The average ADC value of colorectal cancer metastasis of the reproducible coefficient of 0.20 × 10-3mm2 / s. ④ ADC value and metastasis of proliferation index and BCL-2 expression.